Postpartum IUD contraception — a review of an international experience

Chi, I‐cheng; Farr, Gaston

doi:10.1007/bf01849356

Cited by 44 publications

(33 citation statements)

References 39 publications

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“…5 Also, postpartum IUCD insertion is not associated with an increased risk of infection, uterine perforation, postpartum bleeding or uterine subinvolution. 6 This study was conducted to evaluate the safety and efficacy of immediate postpartum intrauterine contraceptive device (PPIUCD) insertion in women delivering vaginally or by cesarean section.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of efficacy, expulsion and safety of post-placental and intra-cesarean insertion of intrauterine contraceptive devices

Singh

Malik

Ahalawat

et al. 2015

Int J Reprod Contracept Obstet Gynecol

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Section: Introductionmentioning

confidence: 99%

Evaluation of efficacy, expulsion and safety of post-placental and intra-cesarean insertion of intrauterine contraceptive devices

Singh

Malik

Ahalawat

et al. 2015

Int J Reprod Contracept Obstet Gynecol

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“…The expulsion rates in trials of immediate post-partum insertion generally appear lower than those reported with delayed post-partum insertions. 21 After clinical examination, the position of the IUCD was in situ in 97.61% of subjects.…”

mentioning

confidence: 99%

Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion

Kittur

Kabadi

2012

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONMore than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. Contraceptive prevalence is low in developing countries owing to unmet need for contraception. In India the unmet need is estimated to be 15.8% as estimated by DHS survey.1 Half of these women have no positive intention of using contraceptives but still wish to avoid pregnancy. There are multiple opportunities for the health personnel to interact with women during her reproductive cycle like antenatal, natal and postnatal period, and also during Immunization sessions at the Health Institutions and Village Health and nutrition days. Insertion of intra uterine contraceptive device (IUCD) at 10 minutes after delivery is appealing for several reasons:(a) Recommencement of ovulation can be unpredictable after delivery, and the CuT provides exceedingly useful contraception during the puerperium. (b)The woman is also likely to have a high motivation for accepting contraception and the healthcare center provides a convenient setting for insertion of IUCD.(c) In the developing countries, delivery may be the only time when a healthy woman comes into contact with health care providers and the chances of returning for contraceptive advice are uncertain. Family planning programs could use the opportunity of the antepartum ABSTRACT Background: More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. The study was conducted to assess the safety, incidence of perforation /pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Cu T 380 A inserted within ten minutes of placental expulsion both in vaginal and C-section deliveries. Methods:This was an open label, prospective, and longitudinal study. The study was approved by the ethics committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) at KIMS, Hubli was easy in 99.52% of subjects after normal delivery and 100% in all subjects after assisted vaginal deliveries. The position of the CuT was in situ in 94.78% of subjects, ultra sonogram was used in 24.76 % to confirm location where threads were not visible in the vagina and in 6.19% of subjects the tip of IUCD was in the cervix which was pushed back into the uterus using artery forceps. It was expelled in 5.23% of patients. There was no case of perforation in this series and no other major complications. Conclusions: Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus.

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“…8–10 Postplacental insertion has an expulsion rate ranging from 6% to 20% for T-shaped IUDs over 1 year. 11–14 The expulsion rate is lower for immediate postplacental compared with early (11 minutes to 72 hours) postpartum insertion and is also lower when skilled health care providers insert the IUD. 11,12 The method of postpartum insertion, whether inserted by ring forceps or by hand, does not appear to affect expulsions.…”

mentioning

confidence: 99%

Postplacental or Delayed Insertion of the Levonorgestrel Intrauterine Device After Vaginal Delivery

Chen

Reeves

Hayes

et al. 2010

Obstetrics & Gynecology

168

115

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OBJECTIVE To estimate whether 6-month use of the levonorgestrel-releasing intrauterine device (IUD) would be higher when insertion occurred within 10 minutes of placental delivery compared with 6–8 weeks postpartum. METHODS We enrolled pregnant women planning vaginal deliveries and desiring a postpartum levonorgestrel-releasing IUD. Patients were randomly assigned when admitted in labor to postplacental or delayed IUD insertion. The women followed up in person at 6–8 weeks and 6 months and were contacted by telephone at 3 months. Women were ineligible for a study IUD postenrollment for intrapartum events including infection, hemorrhage, and cesarean delivery; these women were contacted by phone at 3 and 6 months. Expelled IUDs were replaced per patient preference. RESULTS Successful IUD placement occurred in 50 of 51 participants (98.0%) and 46 of 51 participants (90.2%) in the postplacental and delayed groups, respectively (P=.2). Expulsion within 6 months occurred in 12 of 50 (24.0%; 95% confidence interval [CI], 13.1–38.2) and two of 46 (4.4%; 95% CI 0.5–14.8) participants, respectively (P=.008). Intrauterine device use at 6 months was 43 of 51 (84.3%; 95% CI 71.4–93.0) and 39 of 51 (76.5%; 95% CI 62.5–87.2), respectively (P=.32). For ineligible patients, only 11 of 41 (26.8%) women were using IUDs at 6 months and two (4.9%) had become pregnant. CONCLUSION Intrauterine device use 6 months after delivery is similar in women who have postpartum or scheduled delayed IUD placement through a study after replacement of expelled IUDs. Expulsions are significantly higher with postplacental compared with delayed IUD placement. Women asked to follow up with their own health care providers for delayed insertion are significantly less likely to receive an IUD. CLINICALTRIALREGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00476021. LEVEL OF EVIDENCE I

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Postpartum IUD contraception — a review of an international experience

Cited by 44 publications

References 39 publications

Evaluation of efficacy, expulsion and safety of post-placental and intra-cesarean insertion of intrauterine contraceptive devices

Evaluation of efficacy, expulsion and safety of post-placental and intra-cesarean insertion of intrauterine contraceptive devices

Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion

Postplacental or Delayed Insertion of the Levonorgestrel Intrauterine Device After Vaginal Delivery

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